NC Medicaid Managed Care Provider Update – Oct. 27, 2022

Upcoming Key Milestones for NC Medicaid Managed Care

Provider Playbook Updates

The Provider Playbook is a collection of information and tools specifically designed to assist providers transitioning to NC Medicaid Managed Care. The latest resources are added to the fact sheet page.

• Nursing Facility - PHP Process - Oct. 17, 2022
• Nursing Facility Placement - Oct. 17, 2022
• Panel Management - Sept. 14, 2022
• Tailored Plan Member Enrollment: PCP/TCM Auto-assignment - Aug. 17, 2022
• Contracting with Tailored Plans - Aug. 11, 2022

Verifying NC Medicaid Eligibility for Beneficiaries

Providers are reminded to verify eligibility, health plan and primary care provider enrollment as beneficiaries present at the office for care and prior to rendering services using the NCTracks Recipient Eligibility Verification/Response. Member ID cards are not required to provide services, including pharmacies, so members should not be turned away due to the lack of a Member ID card in their possession. Upon discovery that a beneficiary is not eligible for Medicaid, the practice should refer the beneficiary to the county department of social services (DSS) agency for assistance.  

For more information, see the Fact Sheet What Providers Need to Know: Part 2 – After Managed Care Launch or the Confirming Medicaid Coverage for Beneficiaries bulletin.

Provider Reverification

As the federal Public Health Emergency (PHE) comes to an end, providers will begin receiving reverification notices again. These notices will be sent to providers with approaching reverification due dates, as well as those whose reverification was suspended during the PHE. For more information, see Provider Reverification Requirements to be Reinstated.

IMPORTANT: Verify Your NCTracks Provider Record is Current

Providers are contractually obligated to maintain their NCTracks provider enrollment information. This includes ensuring that the designated Office Administrator and all email addresses on the provider record remain current so designated personnel may receive and respond to notifications. Providers may review their full enrollment information on their NCTracks record by initiating a Manage Change Request from the Status and Management page of the secure Provider Portal. 

The Department has also updated the Interim Report to Assist providers In Verifying their Record which offers a quick view the portion of the record that displays in the Medicaid and NC Health Choice Provider and Health Plan Lookup Tool. For assistance with reporting changes through the NCTracks Manage Change Request, providers should reference the NCTracks Provider User Guides and Training tools or contact the NCTracks Call Center at 800-688-6696.

Provider Ombudsman 

Each health plan has a grievance and appeal process for providers, separate from the process for beneficiaries, which can be found in each health plan’s Provider Manual, linked on the Health Plan Contacts and Resources Page.

The Provider Ombudsman service is separate from the Health Plans’ Provider Grievances and Appeals process and should be used as an escalation after contacting Health Plans and searching the NC Medicaid Help Center.

Inquiries may be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov or by calling the NC Medicaid Managed Care Provider Ombudsman at 866-304-7062.

Help Center Available for Providers to Find Information

The NC Medicaid Help Center is an online source of information about Managed Care, COVID-19 and Medicaid and behavioral health services, and is also used to view answers to questions from the NC Medicaid Help Center mailbox, webinars and other sources. To use this new tool:

1. Go to NC Medicaid Help Center
2. Type a topic or key words into the search bar
3. Select a topic from the available list of  categories

Detailed information about the NC Medicaid Help Center is available in a Medicaid Bulletin updated on June 17, 2021.

NC Medicaid Managed Care Webinars

Visit the AHEC Medicaid Managed Care webpage for additional information and registration for upcoming webinars, as well as recordings, slides and transcripts from previous webinars.

The latest schedule, registration and information on previous webinars, including the recording, slides, and transcript are available on the AHEC Medicaid Managed Care webpage. 

Contact

NCTracks Call Center: 800-688-6696

Provider Ombudsman: 866-304-7062